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Word
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Definition
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E&O
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E&O: See Errors and Omissions Insurance.
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E&S
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E&S: See Excess and Surplus Lines Insurance.
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EAP
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EAP: See Employee Assistance Program.
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Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
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Early and Periodic Screening, Diagnosis and Treatment (EPSDT): Programs that cover screening and diagnostic services to determine physical or mental defects in recipients under age 21, as well as health care and other measures to correct or ameliorate any defects and chronic conditions discovered.
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Early Warning Tests
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Early Warning Tests: See Insurance Regulatory Information System.
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Earned Premiums
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Earned Premiums: The prorated portion of an insurance premium that no longer is considered prepaid due to the elapsed time the policy has been in force. For example, after six months, $50 of a prepaid $100 annual premium is considered earned premium.
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Earthquake Project
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Earthquake Project: An initiative begun in 1988 by U.S. property-casualty insurers to call attention to losses that would arise from a major earthquake within the United States. The initiative calls for government incentives to enable insurers to build up appropriate reserves for such an event.
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ECF
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ECF: See Extended Care Facility.
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Effective Date
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Effective Date: The date on which coverage begins under an insurance policy.
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Eligibility Date
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Eligibility Date: The date on which a participant's eligibility period begins.
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Eligibility Date
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Eligibility Date: The day on which an employee becomes eligible for insurance, after
completing a plan's waiting period.
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Eligibility Period
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Eligibility Period: The amount of time during which qualified participants in a group policy may choose to participate as members of the insured group without furnishing evidence of insurability.
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Eligible Survivor
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Eligible Survivor: In LTD plans, a deceased employee's surviving spouse; if no spouse
survives, then the employee's children under a certain age (e.g. 25)
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Elimination Period
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Elimination Period: The number of consecutive days an employee must be disabled
before LTD benefits become payable (typically, 90 or 180 days). Also known as benefit
waiting period and qualifying period. In some plans, employees are allowed to work during
the elimination period; see residual.
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Elimination Period
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Elimination Period: The initial period of time during which benefits under a health insurance policy are not payable.
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Employee
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Employee: A citizen or permanent resident of the United States or Canada who is in active
employment in the United States with the Employer unless an exception is applied for and
approved in writing by VPA.
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Employee Assistance Program (EAP)
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Employee Assistance Program (EAP): Employer-sponsored program designed to help
employees whose job performance is being adversely affected by personal problems. May
involve wellness and prevention efforts, counseling, and control of specific conditions (e.g.,
alcoholism or smoking). Some employers use EAP's to address the psychological aspects of
disabling injuries or illnesses.
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Employee Assistance Program (EAP)
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Employee Assistance Program (EAP): A mental health managed care program, in which a gatekeeper evaluates a patient before referral for the appropriate course of treatment. The evaluation could include a number of office visits, as well as testing. EAP programs typically were started as an in-house, less expensive way for employees to obtain advice and treatment in such areas as substance abuse and other psychological needs, and have evolved as a way to extend managed care to mental health coverage.
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Employee Retirement Income Security Act (ERISA)
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Employee Retirement Income Security Act (ERISA): Federal legislation enacted in 1974 applicable to most private pension and welfare plans. The legislation seeks to protect covered employees by establishing certain minimum standards for such plans.
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Employee Retirement Income Security Act (ERISA)
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Employee Retirement Income Security Act (ERISA): The main purpose of the
Employee Retirement Income Security Act is to ensure that employees receive the pension
and other benefits promised by their employers. ERISA sets uniform minimum standards to
assure that employee benefit plans are established and maintained in a fair and financially
sound manner. In addition, employers have an obligation to provide promised benefits and
satisfy ERISA's requirements for managing and administering private pension and welfare
plans. Title I of ERISA requires persons and entities who manage and control plan funds to:
·• Manage plans for the exclusive benefit of participants and beneficiaries; ·• Carry out their
duties in a prudent manner and refrain from conflict-of-interest transactions expressly
prohibited by law; ·• Comply with limitations on certain plans' investments in employer
securities and properties; ·• Fund benefits in accordance with the law and plan rules; ·•
Report and disclose information on the operations and financial condition of plans to the
government and participants; ·• Provide documents required in the conduct of investigations
to assure compliance with the law. ERISA supersedes almost all state laws that affect
employee benefit plans and has thus created a single federal standard for employee benefit.
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Employee Stock Ownership Plan (ESOP)
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Employee Stock Ownership Plan (ESOP): A defined contribution pension plan that invests primarily in the securities of the employer.
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Employer
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Employer: The Policyholder: which includes any division, subsidiary or affiliated company
named in the policy.
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Employer
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Employer: The term "employer" means any person acting directly as an employer, or indirectly in the interest of an employer, in relation to an employee benefit plan; and includes a group or association of employers acting for an employer in such capacity. See, 29 U.S.C. § 1002(5) The term implies a bona fide group or association of employers acting in the interest of its employer-members to provide benefits for their employees.
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Employer's First Report of Injury
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Employer's First Report of Injury: A state-required notice of the details of an industrial
accident or occupational disease; must be filed by the employer or its agent with the
workers' compensation insurance carrier and, in most cases, also with the state workers'
compensation agency.
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Endorsement
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Endorsement: An amendment to, or other alteration of, the original insurance policy; also known as a rider.
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Endowment Life Insurance
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Endowment Life Insurance: A form of whole life insurance for which premiums are paid until a fixed date, at which time the policy matures and benefits are available to the policyholder. See Whole Life Insurance.
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End-Stage Renal Disease
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End-Stage Renal Disease: Most people who need a kidney transplant or renal dialysis because of chronic kidney disease are automatically covered under Medicare Part A.
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Enrollee
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Enrollee: Any person eligible as either a subscriber or a dependent for service in accordance with a contract
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Enrollment
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Enrollment: The process of selecting and signing up as a member of a health or disability
plan.
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EPO
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EPO: See Exclusive Provider Organization.
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ERISA
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ERISA: See Employee Retirement Income Security Act.
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ERISA
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ERISA: The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.
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Errors and Omissions (E&O) Insurance
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Errors and Omissions (E&O) Insurance: A form of insurance that covers an insured's liability for any actual or alleged breach or neglect of duty committed in the conduct of the insured's business activities.
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ESOP
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ESOP: See Employee Stock Ownership Plan.
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Essential Functions
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Essential Functions: As defined by the Americans with Disabilities Act, the fundamental
job duties of the position that an individual with a disability holds or seeks. These are
activities that every incumbent in a given job must perform. See also marginal functions.
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Estoppel
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Estoppel: A legal principle by which a person is precluded from denying the veracity of a statement previously made.
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Evidence of Insurability
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Evidence of Insurability: Statement or proof of an individual's medical history, which
determines his or her acceptability for coverage.
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Examination
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Examination: The process whereby regulators inspect the books and records of an insurer to verify their financial condition and compliance with applicable laws and regulations.
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Examiner
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Examiner: Person responsible for the adjudication of disability claims.
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Excess and Surplus (E&S) Lines Insurance
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Excess and Surplus (E&S) Lines Insurance: A form of insurance that covers risks for which insurance is unavailable from admitted insurers.
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Excess and Surplus (E&S) Lines Insurer
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Excess and Surplus (E&S) Lines Insurer: An insurer that, although not licensed to transact business within a given state, writes excess and surplus insurance as a nonadmitted insurer with greater freedom from regulatory restrictions applicable to admitted insurers.
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Excess Surplus
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Excess Surplus: The amount of surplus over and above that required to meet defined required surplus standards. Also known as "free surplus."
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Excess-of-Loss Reinsurance
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Excess-of-Loss Reinsurance: A form of reinsurance in which the insurer cedes and the reinsurer assumes all or a portion of losses in excess of a specified retention level up to a predetermined limit; also known as nonproportional reinsurance.
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Exclusion
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Exclusion: A provision in an insurance policy that eliminates coverage for certain risks, persons, classes of property or locations. In an all-risks policy, excluded items are listed explicitly in the policy. In a named-perils policy, exclusions are understood to be all those risks not listed as being covered.
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Exclusive Agent
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Exclusive Agent: An insurance agent who has agreed to provide exclusive representation to one insurer; also known as a captive agent.
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Exclusive Provider Organization (EPO)
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Exclusive Provider Organization (EPO): A managed care organization that is organized similarly to PPOs in that physicians do not receive capitated payments, but which only allows patients to choose medical care from network providers. If a patient elects to seek care outside of the network, then he or she will not be reimbursed for the cost of the treatment. See Preferred Provider Organizations.
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Exclusivity Clause
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Exclusivity Clause: A part of a contract that prohibits physicians from contracting with more than one managed care organization (HMO, PPO, IPA, etc.).
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Exemplary Damages
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Exemplary Damages: See Punitive Damages.
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Expense Loading
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Expense Loading: See Loading.
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Expense Ratio or Underwriting Expense Ratio
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Expense Ratio or Underwriting Expense Ratio: The ratio of an insurer's underwriting expenses to net premiums written, if determined in accordance with statutory accounting practices; or the ratio of underwriting expenses (adjusted by deferred acquisition costs) and operating expenses (excluding interest expense) to earned premiums, if determined in accordance with generally accepted accounting principles.
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Experience
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Experience: The loss history of an insured or a particular class of business.
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Experience
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Experience: The financial status of an insured group's claim activity relative
to the insurer or self-funding employer. "Good experience" indicates that claims payments
are lower than expected; "bad experience" indicates the opposite.
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Experience Data
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Experience Data: History of premiums, incurred claims, paid claims, open claims, closed
claims, plan changes, rates, and changes in number of covered individuals for a group.
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Experience Rating
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Experience Rating: A method of setting premium levels for an insured based upon the insured's loss history. Also known as retrospective rating.
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Expiration Date
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Expiration Date: The date on which insurance coverage ends.
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Explanation of Benefits (EOB)
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Explanation of Benefits (EOB): A statement mailed to a member or covered insured
explaining how and why a claim was or was not paid; the Medicare version is called an
EOMB.
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Exposure
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Exposure: A unit of measurement of risk being assumed by the insurer. For example, wages serve as the basis for calculating workers' compensation exposure.
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Extended Care Facility (ECF)
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Extended Care Facility (ECF): A nursing or convalescent home offering skilled nursing care and rehabilitation services.
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Extended Coverage Insurance
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Extended Coverage Insurance: Supplemental protection provided against perils in addition to those perils covered in a basic fire insurance policy.
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Extended Warranty Insurance
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Extended Warranty Insurance: A form of insurance that provides warranty protection against faulty construction for a term beyond the warranty period provided by the manufacturer.
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Extra-Contractual Obligations or Liability
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Extra-Contractual Obligations or Liability: See Punitive Damages.
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Exxon Valdez
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Exxon Valdez: A notable casualty loss resulting from the grounding of the oil supertanker, Exxon Valdez, off the coast of Alaska in 1989.
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